Practice

Cases in primary care laboratory medicine

Hypertriglyceridaemia in diabetes

BMJ 2006; 333 doi: 10.1136/bmj.39043.398738.DE (Published 14 December 2006)
Cite this as: BMJ 2006;333:1257

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  1. W Stuart A Smellie, consultant
  1. 1Clinical Laboratory, General Hospital, Bishop Auckland DL14 6AD
  1. info{at}smellie.com
  • Accepted 8 November 2006

Mild hypertriglyceridaemia is common in diabetes, but patients with newly presenting or poorly controlled diabetes may have a quantitatively different syndrome of gross hypertriglyceridaemia, which should be treated by optimising glycaemic control before use of lipid lowering drugs

Summary points

  • Diabetes can be associated with massive hypertriglyceridaemia, with serum triglyceride concentrations ≥100 mmol/l in extreme cases

  • Severe hypertriglyceridaemia represents an extreme of the classic blood lipid pattern in diabetes. It carries a risk of acute pancreatitis, and will be missed if serum triglycerides are not measured. Lipaemic samples should always prompt measurement of fasting triglyceride by the laboratory

  • Diabetes and impaired glucose tolerance are common findings in patients with hypertriglyceridaemia. Fasting glucose should be measured, and a glucose tolerance test performed if indicated, in hypertriglyceridaemic patients

  • Hypertriglyceridaemia due to poor diabetic control does not respond well to lipid lowering agents. Treating the diabetes is the first priority, although many patients will also have an underlying dyslipidaemia

  • Serious metabolic consequences of poor diabetic control are not reflected in patients' symptoms

Diagnostics lack the robust evidence base available to other interventional medical practices, but considerable consensus guidance obtained from observational and intervention studies is available to guide optimal use of laboratory tests. This includes measurement of serum triglycerides in patients in whom lipid lowering is being considered.

This article considers two cases of hypertriglyceridaemia in diabetes. Such cases are not infrequently referred to lipid clinics or prompt questions about possible laboratory error. In reality they reflect the metabolic consequences of excess glucose substrate in poorly controlled or newly presenting diabetes, usually in association with an underlying defect of triglyceride metabolism. Treatment is of the precipitating factor (that is, hyperglycaemia) rather than with lipid lowering drugs in the first instance, as part of the global management of the diabetes and risk factors for other diabetic …

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